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Published on: August 8, 2022
Clinical management and healthcare resource utilization among patients with obstructive hypertrophic cardiomyopathy
Roberto Barriales-Villa1, Luis Escobar-López2, David Vilanova Larena3
1Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
Insights
Obstructive hypertrophic cardiomyopathy (oHCM) significantly impacts Spanish patients, increasing hospitalizations, mortality, and healthcare costs with symptom severity. Septal reduction therapies (SRT) offered partial symptom relief in advanced cases.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Obstructive hypertrophic cardiomyopathy (oHCM) affects a significant portion of hypertrophic cardiomyopathy (HCM) patients, leading to severe symptoms like dyspnea and heart failure.
- Comprehensive data on oHCM management and its associated burden in Spain is lacking.
Purpose of the Study:
- To analyze the current management of oHCM patients in Spain.
- To determine the clinical and economic burden of oHCM in the Spanish population.
Main Methods:
- Retrospective observational study using electronic medical records (BIG-PAC) from January 2014 to October 2022.
- Inclusion of 752 adult patients diagnosed with oHCM.
- Analysis of epidemiology, patient characteristics, management, NYHA class transitions, healthcare resource utilization (HCRU), and costs.
Main Results:
- The prevalence of HCM and oHCM was 28 and 7 per 10,000 individuals, respectively.
- Patients were predominantly treated with beta-blockers; septal reduction therapies (SRT) were used in 13.1% (NYHA-III) and 47.7% (NYHA-IV) of patients.
- Symptom severity (NYHA class) correlated with increased hospitalizations, cardiovascular events, mortality, HCRU, and costs, ranging from €4142 (NYHA-I) to €16,677 (NYHA-IV) annually.
Conclusions:
- This study is the first in Spain to assess oHCM management and its clinical-economic impact.
- Increased hospitalizations, mortality, HCRU, and costs are associated with oHCM progression, mirroring NYHA functional class.
- SRT demonstrated partial symptom improvement in patients with advanced oHCM.
Introduction And Objectives:
Obstructive hypertrophic cardiomyopathy (oHCM), whose symptoms range from dyspnea to heart failure or sudden cardiac death, accounts for approximately 70% of all hypertrophic cardiomyopathy cases. This study aimed to analyze the lack of comprehensive data on oHCM management and determine its clinical and economic burden in Spain.
Methods:
This retrospective observational study, based on electronic medical records (BIG-PAC), enrolled adults from 1 January 2014, to 31 October 2022, from the time of HCM diagnosis. The analysis focused on epidemiology, patient characteristics and management, transitions between New York Heart Association (NYHA) functional classes, healthcare resource utilization (HCRU), and associated costs.
Results:
A total of 752 oHCM patients were included (mean age: 63 years; male: 57.6%). NYHA functional classification at diagnosis was as follows: 12% NYHA-I, 47.9% NYHA-II, 31.5% NYHA-III, and 8.6% NYHA-IV. The prevalence of HCM and oHCM was 28 and 7 per 10 000 individuals, respectively. Patients received a mean of 2.4 (SD 1.5) treatments, mainly beta-blockers. Only patients in NYHA classes III and IV underwent septal reduction therapies (SRT) (13.1% and 47.7%, respectively); 38.7% and 35.5% of NYHA-III and -IV patients who received SRT, respectively, improved to a lower NYHA class. Symptom severity, as measured by NYHA class, was associated with increased rates of hospitalization, cardiovascular events, mortality, and higher HCRU and costs. Mean annualized, direct, adjusted health care costs ranged from €4142 (95%CI: €3110-€5175) in NYHA-I to €16 677 (95%CI: €15 482-€17 872) in NYHA-IV.
Conclusions:
This is the first Spanish study to evaluate oHCM patient management and to demonstrate its impact in terms of increased hospitalizations, mortality, HCRU, and healthcare costs, trends that parallel the progression of symptoms by NYHA functional class. Patients who underwent SRT showed partial symptom improvement.
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